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Jiun Lap Do, Jessica Cao, Sahar Bedrood, Jesse L Berry, Grace Richter; Comparison of Ahmed versus Baerveldt Implants in Managing Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6488.
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© ARVO (1962-2015); The Authors (2016-present)
Glaucoma drainage implants (GDI) are used to manage elevated intraocular pressures (IOP) in neovascular glaucoma (NVG); however, there is little information comparing GDIs in managing NVG. This study compared the effectiveness of Ahmed and Baerveldt GDIs in the management of NVG.
A retrospective chart review of eyes that received GDIs at LAC+USC Medical Center in a five-year period was conducted. Patients were stratified into Ahmed or Baerveldt groups, excluding those with prior GDIs or indications other than NVG. Primary outcome measures of visual acuity and IOP were assessed by chi-square and Student’s t-test. Failure was defined as treated IOP>22 mm Hg, additional glaucoma surgery, or loss of light perception.
82 eyes received GDIs for NVG. Baseline characteristics between the Ahmed and Baerveldt group (age, gender, ethnicity, NVG etiology, presenting and presurgical visual acuity, and presenting IOP) did not differ except for presurgical IOP (42.5±13.0 mm Hg and 31.1±8.5 mm Hg, respectively, p < 0.001). There was no significant difference between groups in visual acuity or visual acuity change at postoperative day 1 (POD1), POD7, postoperative month 1 (POM1), POM3, or POM6 (POM6: Ahmed 1.723±1.071 logMAR, Baerveldt 1.614±1.107 logMAR, p = 0.725). The Ahmed group had lower IOP at POD1 and POD7 compared to the Baerveldt group (POD1: 14.5±11.5 mm Hg, 20.4±12.1 mm Hg, p = 0.034; POWD7: 12.7±8.3 mm Hg, 19.9±13.1 mm Hg, p = 0.003, respectively). At POM1 and POM3, the Baerveldt group had lower IOP than the Ahmed group (POM1: 16.2±9.8 mm Hg, 22.4±11.3 mm Hg, p = 0.013; POM3: 15.3±9.0 mm Hg, 20.6±9.4 mm Hg, p = 0.017, respectively). There was no difference between groups at POM6 in IOP (Ahmed 18.6±10.5 mm Hg, Baerveldt 16.1±9.1 mm Hg, p = 0.329), change in IOP (Ahmed -23±16.7 mm Hg, Baerveldt -15.6±11.4 mm Hg, p = 0.515), or number of medications (Ahmed 2.5±1.6, Baerveldt 2.0±1.6, p = 0.159). Failure rates between Ahmed and Baerveldt groups was not statistically significant (42%, 17.9%, respectively, p = 0.061).
Our results suggest that there is no difference in visual acuity, IOP, or failure rates whether Ahmed or Baerveldt GDIs are used to treat NVG. Though the Ahmed group trended toward higher failure rates, higher presurgical IOP necessitating additional surgery may account for this trend. Further analysis is necessary to determine outcomes and failure rates on extended follow-up.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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